•Eligible commercially insured patients may be able to receive financial assistance with their medication and medication administration costs
•Administration Copay Program will cover only specific, approved billing codes that relate to anesthesia, imaging procedures, and/or surgical procedure or drug administration. The program does not cover lab work, observation, surgical supplies, facility/room costs, or other miscellaneous costs that may be associated with the administration of Qalsody
•Residents of Massachusetts, Minnesota, or Rhode Island are not eligible for the Administration Copay program
•HCP should fax completed start form to 8885389781 or email: StartForm@Biogen.com
•For assistance or additional information, call 8777257639, MondayFriday from 8:30 AM to 8 PM ET